Serial Coronary Angiographic Evidence That Antioxidant Vitamin Intake Reduces Progression of Coronary Artery Atherosclerosis
- Howard N. Hodis, MD;
- Wendy J. Mack, PhD;
- Laurie LaBree, MS;
- Linda Cashin-Hemphill, MD;
- Alex Sevanian, PhD;
- Ruth Johnson, RD, MA;
- Stanley P. Azen, PhD
- From the Atherosclerosis Research Unit, Division of Cardiology, Department of Medicine (Drs Hodis, Mack, Cashin-Hemphill, Sevanian, and Azen and Mss LaBree and Johnson), and the Statistical Consultation and Research Center, Department of Preventive Medicine (Drs Hodis, Mack, and Azen and Ms LaBree), University of Southern California School of Medicine, and the Department of Molecular Pharmacology and Toxicology, University of Southern California School of Pharmacy (Drs Hodis and Sevanian), Los Angeles.
Abstract
Objective. —To explore the association of supplementary and dietary vitamin E and C intake with the progression of coronary artery disease.
Design. —A subgroup analysis of the on-trial antioxidant vitamin intake database acquired in the Cholesterol Lowering Atherosclerosis Study, a randomized, placebo-controlled, serial angiographic clinical trial evaluating the risk and benefit of colestipol-niacin on coronary artery disease progression.
Setting. —Community- and university-based cardiac catheterization laboratories.
Subjects. —A total of 156 men aged 40 to 59 years with previous coronary artery bypass graft surgery.
Intervention. —Supplementary and dietary vitamin E and C intake (nonrandomized) in association with cholesterol-lowering diet and either colestipol-niacin or placebo (randomized).
Outcome. —Change per subject in the percentage of vessel diameter obstructed because of stenosis (%S) determined by quantitative coronary angiography after 2 years of randomized therapy on all lesions, mild/moderate lesions (<50%S), and severe lesions (≥50%S).
Results. —Overall, subjects with supplementary vitamin E intake of 100 IU per day or greater demonstrated less coronary artery lesion progression than did subjects with supplementary vitamin E intake less than 100 IU per day for all lesions (P=.04) and for mild/moderate lesions (P=.01). Within the drug group, benefit of supplementary vitamin E intake was found for all lesions (P=.02) and mild/moderate lesions (P=.01). Within the placebo group, benefit of supplementary vitamin E intake was not found. No benefit was found for use of supplementary vitamin C exclusively or in conjunction with supplementary vitamin E, use of multivitamins, or increased dietary intake of vitamin E or vitamin C.
Conclusions. —These results indicate an association between supplementary vitamin E intake and angiographically demonstrated reduction in coronary artery lesion progression. Verification from carefully designed, randomized, serial arterial imaging end point trials is needed.
(JAMA. 1995;273:1849-1854)
Footnotes
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Reprint requests to Atherosclerosis Research Unit, Division of Cardiology, University of Southern California School of Medicine, 2250 Alcazar St, CSC 132, Los Angeles, CA 90033 (Dr Hodis).
